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Organization

LAKESHORE MEDICAL CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL BANIA (SENIOR DIRECTOR)
(414) 766-9094
Entity
Organization

Contact information

Practice address
4202 W OAKWOOD PARK CT, FRANKLIN, WI 53132-8131
(414) 423-5250
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 647-6326

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Enumeration date
06/24/2009
Last updated
07/20/2017
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